Serial Intrauterine Transfusions for a Hydropic Fetus with Severe Anemia and Thrombocytopenia Caused by Parvovirus: Lessons Learned

rates vary according to age and geography. Seasonal varia-tions have been observed. Among susceptible women during endemic and epidemic periods, the rate of seroconversion has been reported as 1.5 and 13.0%, respectively.1 Although hydrops fetalis is a rare complication, it can rapidly lead to fetal demise. Intrauterine transfusion of red cells has been demonstrated to be an effective intervention with an im-proved fetal survival of 83.5%.2 Severe thrombocytopenia has been reported in approximately half of fetuses with hydrops undergoing intrauterine transfusion for parvovirus infection, although the mechanism is not clear.3 Severe thrombocyto-penia can complicate intrauterine transfusion procedures with cases of fetal exsanguination following cordocentesis for other conditions such as alloimmune thrombocytopenia.4 Here we describe a case of severe thrombocytopenia compli-cating intrauterine transfusion for severe fetal anemia caused by parvovirus infection and the unique strategies employed to deal with this condition. Case Report A25-year-old, gravida 3, P2-0-0-0-2,was referred at 27weeks of gestation for evaluation of newly diagnosed nonimmune hydrops. A routine follow-up ultrasound at 26 weeks and 4 days of gestation revealed hydrops fetalis. A comprehensive review of her medical records and her history revealed only exposure at around 20 weeks of gestation to a neighbor’s infant diagnosed with “fifth disease. ” The patient gave no history of febrile illness or rash